As some major Medicare Advantage insurers look to shrink enrollments and exit markets, others say reimbursement cuts from CMS are a chance to refocus strategies and provide a better product to their members.
Payer
From two new CEOs to year-end financial earnings, these are 10 key updates about Blue Cross Blue Shield companies recently reported by Becker's:
In 2024, 36 states offered Medicare Advantage plans to retired employees, according to a report from KFF published May 23.
From two states passing reform laws to an Oregon health system making prior authorization 'a thing of the past' for cancer treatment, here are five prior authorization updates Becker's has reported since
The chair of the Senate Finance Committee is urging CMS to do more to stop fraud on ACA exchanges, KFF Health News reported May 21.
Advertisement
UnitedHealth Group said a proposed class-action lawsuit alleging an AI algorithm wrongfully denied Medicare Advantage patients care should be dismissed because "plaintiffs have failed to exhaust the exclusive administrative appeal process set by the Medicare Act for challenging coverage determinations."
An Oklahoma bill reforming the prior authorization process has been signed into law and goes into effect Jan. 1, The Journal Record reported May 21.
The ACA marketplace hit a record enrollment high of 21 million in 2024, buoyed by federal premium subsidies. In 2020, ACA enrollment was 11 million.
More hospitals are cutting ties with Medicare Advantage plans, and some insurers are bracing for membership losses in 2025. Here are seven Medicare Advantage updates Becker's has reported since May 8.
Through pre-development loans, Centene and building developer McCormack Baron Salazar will enable around $900 million in planning and construction-related activity to accelerate the development of affordable housing.